Healthcare Library Current Awareness Bulletin – Spinal Cord Injuries

Background: The objective of this study was to investigate whether an anti-spasticity medication can facilitate the effects of robotic locomotor treadmill training (LTT) to improve gait function in people with incomplete spinal cord injury (SCI). Methods: Individuals with chronic incomplete SCI were recruited and carried out a 4 week intervention of either locomotor treadmill training (LTT) alone (n=26) or LTT combined with Tizanidine (TizLTT), an anti-spasticity medication (n=22). Gait function was evaluated using clinical outcome measures of gait, speed and endurance. To better understand the underlying mechanisms of the therapeutic effects, maximal strength, active range of motion (AROM) and peak velocity (Vp) of ankle dorsiand planter-flexor muscles were also measured. Differences were assessed using twoway mixed design analysis of variance. The number of subjects that achieved the minimal important difference (MID) for clinical scores was also measured for each group, and the results of those that did attain the MID were compared with those that did not. Results: Both LTT and TizLTT resulted in significant improvements in walking speed and dorsiflexion maximum strength, with no significant differences between them, using group-averaging analysis. However, using the MID analysis, a higher proportion of subjects in the TizLTT group achieved the MID for walking speed (40%) compared with LTT alone (13%). Those that achieved the MID for walking speed were significantly higher functioning at baseline than those that did not in the TizLTT group, and the change in walking speed was associated with the change in dorsiflexion peak velocity (R2=0.40; P<0.05). Conclusion: Tizanidine appears to facilitate the effects of LTT on gait function in individuals with chronic SCI that are higher functioning at baseline. We speculate that this may be due to restoration of inhibitory mechanisms by Tizanidine, resulting in greater stretch in the planterflexor muscles during the LTT. Publication type: Journal: Article Source: EMBASE Full text: Available National Library of Medicine at Journal of Neuroengineering and Rehabilitation Full text: Available National Library of Medicine at Journal of NeuroEngineering and Rehabilitation Full text: Available National Library of Medicine at Journal of NeuroEngineering and Rehabilitation 18.Title: Gene therapy approaches to promoting axonal regeneration after spinal cord injury Citation: Neuromethods, 2015, vol./is. 98/(153-174), 0893-2336;1940-6045 (2015) Author(s): Bo X., Zhang Y. Language: English Abstract: Traumatic spinal cord injury is a devastating medical condition that still lacks any effective treatment. Studies on the pathological processes of spinal cord injury and neural repair indicate that the two main obstacles that prevent successful axonal regeneration and functional recovery are the weak intrinsic regenerative capacity of the neurons and the presence of several types of inhibitory molecules in the central nervous system (CNS). Various strategies have been derived and tested to elevate the regenerative status of injured neurons in the CNS or block the inhibitory molecules. Gene therapy approaches have been viewed as the ideal means to treat spinal cord injured patients as they can achieve long-term and localized delivery of therapeutic molecules in the CNS. Ex vivo gene delivery offers the additional advantage of providing cellular support for regenerating axons. In this chapter, we summarize the latest studies on viral vectormediated gene deliveries in animal models of spinal cord injury. Most of the studies reported so far are aimed at delivery of molecules that prevent cell death, or increase intrinsic regenerating state of injured neurons, or modify the CNS environment to make it permissive for axon growth. We also provide detailed protocols used in our lab on gene therapy approaches in promoting axonal regeneration and functional recovery in three animal models. Publication type: Book Series: Article Source: EMBASE 19.Title: Hyponatremia in spinal cord injury patients: new insight into differentiating between the dilution and depletion forms. Citation: Spinal Cord, 01 April 2015, vol./is. 53/4(291-296), 13624393 Author(s): Kriz, J, Schuck, O, Horackova, M Language: English Abstract: Study design:This is a retrospective study.Objectives:The objectives of this study were to present a new model for differentiating between the dilution and depletion forms of hyponatremia in patients in the postacute phase after spinal cord injury (SCI), and to identify possible etiological factors contributing to hyponatremia in these patients.Setting:University Hospital Motol, Prague, Czech Republic.Methods:Eighty-seven of 352 patients hospitalized in 2008-2012 in the Spinal Cord Unit were hyponatremic. Seventy-four patients had SNa+=130-135 mmol l−1 and 13 patients had SNa+ below 130 mmol l−1. We propose a simple model of an electrolyte solution in which the Na+ concentration is higher than the Cl− concentration, making it possible to compare the effects of dilution and depletion of Na+ and Cl− on the Na+ concentration. The depletion of Na+ and Cl− leads to a significant increase in the Na+/Cl− ratio, with the Na+-Cl− value remaining unchanged. Dilution with water results in a decrease of Na+-Cl− with the Na+/Cl− ratio remaining unchanged.Results:In patients with SNa+ below 130 mmol l−1, hyponatremia was consistent with the depletion model in 46% and with the dilution model in 32%. In patients with SNa+ ranging between 130 and 135 mmol l−1, the respective rates were 34 and 12%.Conclusion:Examination of SNa+-SCl− and SNa+/SCl− in patients with SCI could be helpful in considering whether hyponatremia is consistent either with the NaCl dilution model or with the NaCl depletion model. Further studies are needed for more accurate interpretation of the results, particularly with respect to volume and acidbase disorders. Publication type: journal article Source: CINAHL Full text: Available Nature Publishing Group at Spinal Cord 20.Title: Improvements in long-term survival after spinal cord injury? Citation: Archives of Physical Medicine and Rehabilitation, April 2015, vol./is. 96/4(645-651), 0003-9993;1532-821X (01 Apr 2015) Author(s): Shavelle R.M., Devivo M.J., Brooks J.C., Strauss D.J., Paculdo D.R. Language: English Abstract: Objective To investigate whether there have been improvements in long-term survival after spinal cord injury in recent decades. Design Survival analysis using time-varying covariates. The outcome variable was survival or mortality, and the explanatory variables were age, sex, level and grade of injury, and calendar year. The data were analyzed using the logistic regression model, Poisson regression model with comparison to the general population, and the computation of standardized mortality ratios for various groups. Setting National Spinal Cord Injury Model Systems facilities. Participants Persons (N=31,531) who survived 2 years postinjury, were older than 10 years, and who did not require ventilator support. These persons contributed 484,979 person-years of data, with 8536 deaths over the 1973 to 2012 study period. Interventions Not applicable. Main Outcome Measures Survival; survival relative to the general population; life expectancy. Results After adjustment for age, sex, race, etiology of injury, time since injury, and level and grade of injury, mortality in persons with spinal cord injury was higher in the 2005 to 2012 period than in 1990 to 2004 or 1980 to 1989, the odds ratios for these 3 periods were.857,.826, and.802 as compared with the 1970 to 1979 reference period. Conclusions There was no evidence of improvement. Long-term survival has not changed over the past 30 years. Objective To investigate whether there have been improvements in long-term survival after spinal cord injury in recent decades. Design Survival analysis using time-varying covariates. The outcome variable was survival or mortality, and the explanatory variables were age, sex, level and grade of injury, and calendar year. The data were analyzed using the logistic regression model, Poisson regression model with comparison to the general population, and the computation of standardized mortality ratios for various groups. Setting National Spinal Cord Injury Model Systems facilities. Participants Persons (N=31,531) who survived 2 years postinjury, were older than 10 years, and who did not require ventilator support. These persons contributed 484,979 person-years of data, with 8536 deaths over the 1973 to 2012 study period. Interventions Not applicable. Main Outcome Measures Survival; survival relative to the general population; life expectancy. Results After adjustment for age, sex, race, etiology of injury, time since injury, and level and grade of injury, mortality in persons with spinal cord injury was higher in the 2005 to 2012 period than in 1990 to 2004 or 1980 to 1989, the odds ratios for these 3 periods were.857,.826, and.802 as compared with the 1970 to 1979 reference period. Conclusions There was no evidence of improvement. Long-term survival has not changed over the past 30 years. Publication type: Journal: Article Source: EMBASE Full text: Available ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION at Archives of Physical Medicine and Rehabilitation Full text: Available ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION at Salisbury District Hospital Healthcare Library 21.Title: Inhibin B is lower and anti-Mullerian hormone is similar in serum of men with spinal cord injuries compared to controls Citation: Systems Biology in Reproductive Medicine, April 2015, vol./is. 61/2(72-77), 1939-6368;1939-6376 (01 Apr 2015) Author(s): Ibrahim E., Aballa T.C., Roudebush W.E., Lynne C.M., Brackett N.L. Language: English Abstract: Men with spinal cord injury have a unique semen profile characterized by normal sperm concentration but abnormally low sperm motility and viability. The purpose of our study was to determine if new diagnostic information could be obtained for this population by measuring serum concentrations of inhibin B and anti-Mullerian hormone. These hormones, as well as follicle stimulating hormone, luteinizing hormone, and testosterone, were measured in 30 men with spinal cord injury and 15 age-matched control subjects. Serum concentrations of inhibin B and testosterone were significantly lower in the spinal cord injury group compared to the control group. A statistically significant negative relationship was observed between serum concentrations of inhibin B and follicle stimulating hormone in both the spinal cord injury group and the control group, and between inhibin B and luteinizing hormone in the spinal cord injury group only. A significant positive relationship was also observed between inhibin B and sperm concentration in the spinal cord injury group. Although serum concentrations of inhibin B were significantly lower in the spinal cord injury group than in controls, inhibin B and anti-Mullerian hormone serum concentrations did not provide an additional diagnostic tool for male infertility in this population. This is the first study to determine serum concentrations of inhibin B and anti-Mullerian hormone in men with spinal cord injury. Publication type: Journal: Article Source: EMBASE 22.Title: Intensity dependent effects of transcranial direct current stimulation on corticospinal excitability in chronic spinal cord injury Citation: Archives of Physical Medicine and Rehabilitation, April 2015, vol./is. 96/4(S114-S121), 0003-9993;1532-821X (01 Apr 2015) Author(s): Murray L.M., Edwards D.J., Ruffini G., Labar D., Stampas A., Pascual-Leone A., Cortes M. Language: English Abstract: Objective To investigate the effects of anodal transcranial direct current stimulation (a-tDCS) intensity on corticospinal excitability and affected muscle activation in individuals with chronic spinal cord injury (SCI). Design Singleblind, randomized, sham-controlled, crossover study. Setting Medical research institute and rehabilitation hospital. Participants Volunteers (N=9) with chronic SCI and motor dysfunction in wrist extensor muscles. Interventions Three single session exposures to 20 minutes of a-tDCS (anode over the extensor carpi radialis [ECR] muscle representation on the left primary motor cortex, cathode over the right supraorbital area) using 1mA, 2mA, or sham stimulation, delivered at rest, with at least 1 week between sessions. Main Outcome Measures Corticospinal excitability was assessed with motorevoked potentials (MEPs) from the ECR muscle using surface electromyography after transcranial magnetic stimulation. Changes in spinal excitability, sensory threshold, and muscle strength were also investigated. Results Mean MEP amplitude significantly increased by approximately 40% immediately after 2mA a-tDCS (pre: 0.36+/-0.1mV; post: 0.47+/0.11mV; P=.001), but not with 1mA or sham. Maximal voluntary contraction measures remained unaltered across all conditions. Sensory threshold significantly decreased over time after 1mA (P=.002) and 2mA (P=.039) a-tDCS and did not change with sham. F-wave persistence showed a nonsignificant trend for increase (pre: 32%+/-12%; post: 41%+/-10%; follow-up: 46%+/-12%) after 2mA stimulation. No adverse effects were reported with any of the experimental conditions. Objective To investigate the effects of anodal transcranial direct current stimulation (a-tDCS) intensity on corticospinal excitability and affected muscle activation in individuals with chronic spinal cord injury (SCI). Design Singleblind, randomized, sham-controlled, crossover study. Setting Medical research institute and rehabilitation hospital. Participants Volunteers (N=9) with chronic SCI and motor dysfunction in wrist extensor muscles. Interventions Three single session exposures to 20 minutes of a-tDCS (anode over the extensor carpi radialis [ECR] muscle representation on the left primary motor cortex, cathode over the right supraorbital area) using 1mA, 2mA, or sham stimulation, delivered at rest, with at least 1 week between sessions. Main Outcome Measures Corticospinal excitability was assessed with motorevoked potentials (MEPs) from the ECR muscle using surface electromyography after transcranial magnetic stimulation. Changes in spinal excitability, sensory threshold, and muscle strength were also investigated. Results Mean MEP amplitude significantly increased by approximately 40% immediately after 2mA a-tDCS (pre: 0.36+/-0.1mV; post: 0.47+/0.11mV; P=.001), but not with 1mA or sham. Maximal voluntary contraction measures remained unaltered across all conditions. Sensory threshold significantly decreased over time after 1mA (P=.002) and 2mA (P=.039) a-tDCS and did not change with sham. F-wave persistence showed a nonsignificant trend for increase (pre: 32%+/-12%; post: 41%+/-10%; follow-up: 46%+/-12%) after 2mA stimulation. No adverse effects were reported with any of the experimental conditions. Conclusions The a-tDCS can transiently raise corticospinal excitability to affected muscles in patients with chronic SCI after 2mA stimulation. Sensory perception can improve with both 1 and 2mA stimulation. This study gives support to the safe and effective use of a-tDCS using small electrodes in patients with SCI and highlights the importance of stimulation intensity. Publication type: Journal: Article Source: EMBASE Full text: Available ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION at Archives of Physical Medicine and Rehabilitation Full text: Available ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION at Salisbury District Hospital Healthcare Library 23.Title: International standards for neurological classification of spinal cord injury: classification skills of clinicians versus computational algorithms. Citation: Spinal Cord, 01 April 2015, vol./is. 53/4(324-331), 13624393 Author(s): Schuld, C, Franz, S, van Hedel, H J A, Moosburger, J, Maier, D, Abel, R, van de Meent, H, Curt, A, Weidner, N, Rupp, R Language: English Abstract: Study design:This is a retrospective analysis.Objectives:The objective of this study was to describe and quantify the discrepancy in the classification of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) by clinicians versus a validated computational algorithm.Settings:European Multicenter Study on Human Spinal Cord Injury (EMSCI).Methods:Fully documented ISNCSCI data sets from EMSCI's first years (2003-2005) classified by clinicians (mostly spinal cord medicine residents, who received in-house ISNCSCI training by senior SCI physicians) were computationally reclassified. Any differences in the scoring of sensory and motor levels, American Spinal Injury Association Impairment Scale (AIS) or the zone of partial preservation (ZPP) were quantified.Results:Four hundred and twenty ISNCSCI data sets were evaluated. The lowest agreement was found in motor levels (right: 62.1%, P=0.002; left: 61.8%, P=0.003), followed by motor ZPP (right: 81.6%, P=0.74; left 80.0%, P=0.27) and then AIS (83.4%, P=0.001). Sensory levels and sensory ZPP showed the best concordance (right sensory level: 90.8%, P=0.66; left sensory level: 90.0%, P=0.30; right sensory ZPP: 91.0%, P=0.18; left sensory ZPP: 92.2%, P=0.03). AIS B was most often misinterpreted as AIS C and vice versa (AIS B as C: 29.4% and AIS C as B: 38.6%).Conclusion:Most difficult classification tasks were the correct determination of motor levels and the differentiation between AIS B and AIS C/D. These issues should be addressed in upcoming ISNCSCI revisions. Training is strongly recommended to improve classification skills for clinical practice, as well as for clinical investigators conducting spinal cord studies.Sponsorship:This study is partially funded by the International Foundation for Research in Paraplegia, Zurich, Switzerland. Publication type: journal article Source: CINAHL Full text: Available Nature Publishing Group at Spinal Cord 24.Title: Investigational drugs for the treatment of spinal cord injury: review of preclinical studies and evaluation of clinical trials from Phase I to II. Citation: Expert opinion on investigational drugs, May 2015, vol. 24, no. 5, p. 645-658 (May 2015) Author(s): Nagoshi, Narihito, Fehlings, Michael G Abstract: Efforts in basic research have clarified mechanisms involved in spinal cord injury (SCI), and resulted in positive findings using experimental treatments including cell transplantation and drug administration preclinically. Based on accumulated results, various clinical trials have begun for human SCI. In this review, the authors focus on five investigational drugs: riluzole, minocycline, Rho protein antagonist, magnesium chloride in polyethylene glycol formulation, and basic fibroblast growth factor. All drugs have established safety and tolerability from Phase I clinical trials, and are now in Phase II. They have been proven to have neuroprotective and/or neuroregenerative effects in animal models of SCI. To date, diverse drugs have been translated into clinical trials, but none have reached clinical application. A key gap was the lack of reliable biomarkers for SCI to fast-track Phase I/II trials. Furthermore, problems were often due to lack of adequate outcome assessments for both animal models and SCI patients. In order to advance clinical trials more quickly and with greater success, more clinically relevant animal models should be used in basic research. Clinically, it is indispensable to use appropriate outcome measurements and to construct a wide network among clinical centers to validate the efficacy of drugs. Source: Medline 25.Title: Lifetime prevalence of chronic health conditions among persons with spinal cord injury Citation: Archives of Physical Medicine and Rehabilitation, April 2015, vol./is. 96/4(673-679), 0003-9993;1532-821X (01 Apr 2015) Author(s): Saunders L.L., Clarke A., Tate D.G., Forchheimer M., Krause J.S. Language: English Abstract: Objective To assess lifetime prevalence of 7 chronic health conditions (CHCs) among a cohort of adults with chronic traumatic spinal cord injury (SCI). Design Cross-sectional. Setting Rehabilitation hospital. Participants Adults with SCI who were >18 years of age, were >1 year postinjury, and had residual neurologic effects impeding full recovery (n=1678). Interventions Not applicable. Main Outcome Measures CHCs were measured using questions from the Behavioral Risk Factor Surveillance System for diabetes (not including gestational), heart attack (also called a myocardial infarction), angina or coronary artery disease, stroke, hypertension (not including during pregnancy), high blood cholesterol, or cancer. Results Of participants, 49.5% reported having at least 1 CHC, with 23.2% reporting >2 CHCs. The most frequently reported CHC was high cholesterol (29.3%) followed by hypertension (28.7%) and diabetes (11.8%). Although the prevalence of CHCs significantly increased with increasing age, only hypertension and cancer were significantly associated with years postinjury. Four CHCs (diabetes, coronary artery disease, hypertension, high cholesterol) were significantly related to mobility status as measured by injury level and ambulatory status. However, after controlling for age, years postinjury, sex, and race, mobility status became nonsignificant in relation to coronary Objective To assess lifetime prevalence of 7 chronic health conditions (CHCs) among a cohort of adults with chronic traumatic spinal cord injury (SCI). Design Cross-sectional. Setting Rehabilitation hospital. Participants Adults with SCI who were >18 years of age, were >1 year postinjury, and had residual neurologic effects impeding full recovery (n=1678). Interventions Not applicable. Main Outcome Measures CHCs were measured using questions from the Behavioral Risk Factor Surveillance System for diabetes (not including gestational), heart attack (also called a myocardial infarction), angina or coronary artery disease, stroke, hypertension (not including during pregnancy), high blood cholesterol, or cancer. Results Of participants, 49.5% reported having at least 1 CHC, with 23.2% reporting >2 CHCs. The most frequently reported CHC was high cholesterol (29.3%) followed by hypertension (28.7%) and diabetes (11.8%). Although the prevalence of CHCs significantly increased with increasing age, only hypertension and cancer were significantly associated with years postinjury. Four CHCs (diabetes, coronary artery disease, hypertension, high cholesterol) were significantly related to mobility status as measured by injury level and ambulatory status. However, after controlling for age, years postinjury, sex, and race, mobility status became nonsignificant in relation to coronary artery disease, but it remained significantly associated with diabetes, hypertension, and high cholesterol. Conclusions Clinicians should be aware of the risk of CHCs in persons with SCI and should screen for these conditions and regular maintenance activities related to SCI. Publication type: Journal: Article Source: EMBASE Full text: Available ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION at Archives of Physical Medicine and Rehabilitation Full text: Available ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION at Salisbury District Hospital Healthcare Library 26.Title: Mobility, Continence, and Life Expectancy in Persons with ASIA Impairment Scale Grade D Spinal Cord Injuries. Citation: American Journal of Physical Medicine & Rehabilitation, 01 March 2015, vol./is. 94/3(180-191), 08949115 Author(s): Shavelle, Robert M., Paculdo, David R., Tran, Linh M., Strauss, David J., Brooks, Jordan C., DeVivo, Michael J. Language: English Abstract: Objective: Previous research on the life expectancy of persons with American Spinal Injury Association (ASIA) Impairment Scale Grade D spinal cord injury has considered them as a large homogenous group, making no functional or medical distinctions. This study sought to (1) determine how survival in this group depends on ambulatory function and the extent of bowel or bladder dysfunction, (2) compute life expectancies for various subgroups, and (3) examine whether survival has improved over time. Design: Data were from 8,206 adults with ASIA Impairment Scale Grade D spinal cord injury in the Spinal Cord Injury Model Systems database who were not ventilator dependent and who survived more than 1 yr after injury. There were a total of 1 14,739 person-years of follow-up and 1,730 deaths during the 1970-201 1 study period. Empirical ageand sex-specific mortality rates were computed. Regression analysis of survival data with timedependent covariates was used to determine the effect of risk factors, to test for a time trend, and to estimate mortality rates for subgroups. Life expectancies were obtained from life tables constructed for each subgroup. Results: The ability to walk, whether independently or with an assistive device, was associated with longer survival than wheelchair dependence. The need for an indwelling catheter, and to a lesser extent intermittent catheterization, was associated with increased mortality risk. Persons who walked unaided and who did not require catheterization had life expectancies roughly 90% of normal. Those who required a wheelchair for locomotion had life expectancies comparable with that in paraplegia, less than 75% of normal. No time trend in survival was found. Conclusions: Life expectancy of persons with ASIA Impairment Scale D spinal cord injury depends strongly on the ability to walk and the need for catheterization. Publication type: journal article Source: CINAHL Full text: Available American journal of physical medicine & rehabilitation / Association of Academic Physiatrists at American Journal of Physical Medicine and Rehabilitation 27.Title: Neural markers of neuropathic pain associated with maladaptive plasticity in spinal cord injury. Citation: Pain practice : the official journal of World Institute of Pain, Apr 2015, vol. 15, no. 4, p. 371-377 (April 2015) Author(s): Pascoal-Faria, Paula, Yalcin, Nilufer, Fregni, Felipe Abstract: Given the potential use of neural markers for the development of novel treatments in spinal cord pain, we aimed to characterize the most effective neural markers of neuropathic pain following spinal cord injury (SCI). A systematic PubMed review was conducted, compiling studies that were published prior to April, 2014 that examined neural markers associated with neuropathic pain after SCI using electrophysiological and neuroimaging techniques. We identified 6 studies: Four using electroencephalogram (EEG); 1 using magnetic resonance imaging (MRI) and FDG-PET (positron emission tomography); and 1 using MR spectroscopy. The EEG recordings suggested a reduction in alpha EEG peak frequency activity in the frontal regions of SCI patients with neuropathic pain. The MRI scans showed volume loss, primarily in the gray matter of the left dorsolateral prefrontal cortex, and by FDG-PET, hypometabolism in the medial prefrontal cortex was observed in SCI patients with neuropathic pain compared with healthy subjects. In the MR spectroscopy findings, the presence of pain was associated with changes in the prefrontal cortex and anterior cingulate cortex. When analyzed together, the results of these studies seem to point out to a common marker of pain in SCI characterized by decreased cortical activity in frontal areas and possibly increased subcortical activity. These results may contribute to planning further mechanistic studies as to better understand the mechanisms by which neuropathic pain is modulated in patients with SCI as well as clinical studies investigating best responders of treatment. © 2014 World Institute of Pain. Source: Medline 28.Title: Neuromodulation by surface electrical stimulation of peripheral nerves for reduction of detrusor overactivity in patients with spinal cord injury: A pilot study Citation: Journal of Spinal Cord Medicine, March 2015, vol./is. 38/2(207-213), 1079-0268;2045-7723 (01 Mar 2015) Author(s): Ojha R., George J., Chandy B.R., Tharion G., Devasahayam S.R. Language: English Abstract: Objectives: To demonstrate reduction in detrusor overactivity using surface electrical stimulation of posterior tibial nerve (PTN) or dorsal penile nerve (DPN) in patients with spinal cord injury (SCI). Design: Patients with SCI with symptoms of urinary urgency/leaks, with cystometrogram (CMG) proven detrusor overactivity were recruited in this study. Ten persons with observable F-wave from tibial nerve were included in the PTN group. Five persons who had FObjectives: To demonstrate reduction in detrusor overactivity using surface electrical stimulation of posterior tibial nerve (PTN) or dorsal penile nerve (DPN) in patients with spinal cord injury (SCI). Design: Patients with SCI with symptoms of urinary urgency/leaks, with cystometrogram (CMG) proven detrusor overactivity were recruited in this study. Ten persons with observable F-wave from tibial nerve were included in the PTN group. Five persons who had Fwave absent but preserved bulbocavernosus reflex were included in the DPN group. Stimulation was given at 20 Hz, 10-40 mA for 20 minutes/session/day for 14 consecutive days. Detrusor overactivity was recorded using CMG on days 1 and 15. Settings: Rehabilitation Institute, Department of Physical Medicine and Rehabilitation, Christian Medical College and Hospital, Vellore, TN, India. Participants: Patients with SCI. Interventions: Surface stimulation of peripheral nerves for reduction of detrusor overactivity. Outcome measures: Qualitative analysis using voiding diary data and quantitative analysis using CMG data comparing preand post-intervention. Results: P value obtained from voiding chart was 0.021 for PTN and 0.062 for DPN. P value obtained from CMG data was not significant in both groups. In one subject, treatment was extended to 4 weeks and further improvement in voiding diary was seen. Conclusions: In this pilot study of 15 patients, voiding chart data showed statistically significant improvement following PTN stimulation and trend of improvement following DPN stimulation. However, the CMG data were not statistically significant in this sample population. Further studies with larger, appropriately powered sample size would be helpful to demonstrate the associations of symptoms with CMG data. Publication type: Journal: Article Source: EMBASE Full text: Available Salisbury EJournals at Journal of Spinal Cord Medicine 29.Title: Osteoporosis in Individuals with Spinal Cord Injury Citation: PM and R, February 2015, vol./is. 7/2(188-201), 1934-1482 (01 Feb 2015) Author(s): Bauman W.A., Cardozo C.P. Language: English Abstract: The pathophysiology, clinical considerations, and relevant experimental findings with regard to osteoporosis in individuals with spinal cord injury (SCI) will be discussed. The bone loss that occurs acutely after more neurologically motor complete SCI is unique for its sublesional skeletal distribution and rate, at certain skeletal sites approaching 1% of bone mineral density per week, and its resistance to currently available treatments. The areas of high bone loss include the distal femur, proximal tibia, and more distal boney sites. Evidence from a study performed in monozygotic twins discordant for SCI indicates that sublesional bone loss in the twin with SCI increases for several decades, strongly suggesting that the heightened net bone loss after SCI may persist for an extended period of time. The increased frequency of fragility fracture after paralysis will be discussed, and a few risk factors for such fractures after SCI will be examined. Because vitamin D deficiency, regardless of disability, is a relevant consideration for bone health, as well as an easily reversible condition, the increased prevalence of and treatment target values for vitamin D in this deficiency state in the SCI population will be reviewed. Pharmacological and mechanical approaches to preserving bone integrity in persons with acute and chronic SCI will be reviewed, with emphasis placed on efficacy and practicality. Emerging osteoanabolic agents that improve functioning of WNT/beta-catenin signaling after paralysis will be introduced as therapeutic interventions that may hold promise. Publication type: Journal: Article Source: EMBASE 30.Title: Patient experience survey in telemedicine for spinal cord injury patients. Citation: Spinal Cord, 01 April 2015, vol./is. 53/4(320-323), 13624393 Author(s): Yuen, J, Thiyagarajan, C A, Belci, M Language: English Abstract: Study design:Patient feedback study.Objectives:To measure how patients value the telemedicine consultation service at the National Spinal Injuries Centre over a period of 8 months.Setting:United Kingdom (south of England).Methods:Telephone survey conducted by an external surveyor who does not work in the department.Results:Our study showed that most patients (n=29) found the service of high quality and useful to their care.Conclusion:This provides evidence, from the spinal cord injury patients' perspective, that telemedicine service has an important role in their management. Publication type: journal article Source: CINAHL Full text: Available Nature Publishing Group at Spinal Cord 31.Title: Postural control during gait initiation and termination of adults with incomplete spinal cord injury Citation: Human Movement Science, June 2015, vol./is. 41/(20-31), 0167-9457;1872-7646 (June 01, 2015) Author(s): Lemay J.-F., Duclos C., Nadeau S., Gagnon D.H. Language: English Abstract: Gait initiation and termination are potentially challenging tasks for balance due to the transition from a quasistatic bipedal phase to a dynamic single-support phase. The purpose of this study was to compare the bipedal and singlesupport phases of gait initiation and termination in individuals with incomplete spinal cord injury (ISCI). Twelve individuals with ISCI were evaluated on the dynamic and postural components of balance using the stabilizing and destabilizing forces during gait initiation, termination and natural gait. Phase comparisons were made using non parametric tests. Visual inspection of the force profile of the factors explaining the forces was also conducted. Gait termination challenged more the postural control during the single-support phase than the bipedal phase for the dynamic component of the stabilizing/destabilizing forces model (p= .002). For gait initiation, the most challenging phase varied with the components analyzed (single-support phase for the dynamic component, bipedal phase for the postural component) (p<. .008). The single support phase is more challenged during gait termination (both components) (p<. .015) while the bipedal phase is more challenged during gait initiation (dynamic components) (p= .012). The stabilizing force and the speed of the center of mass on the one hand, and destabilizing force and the distance between the center of pressure and the base of support on the other hand, had a similar profile. The single-support phase of gait termination was the most challenging among all phases evaluated, being as challenging as the single-support phase of level natural gait. This phase should be targeted in rehabilitation in order to improve balance and decrease the risk of falling in this population. Publication type: Journal: Article Source: EMBASE 32.Title: Pressure changes under the ischial tuberosities during gluteal neuromuscular stimulation in spinal cord injury: A comparison of sacral nerve root stimulation with surface functional electrical stimulation Citation: Archives of Physical Medicine and Rehabilitation, April 2015, vol./is. 96/4(620-626), 0003-9993;1532-821X (01 Apr 2015) Author(s): Liu L.Q., Ferguson-Pell M. Language: English Abstract: Objective To compare the magnitude of interface pressure changes during gluteal maximus contraction by stimulating sacral nerve roots with surface electrical stimulations in patients with spinal cord injuries (SCIs). Design Pilot interventional study. Setting Spinal injury research laboratory. Participants Adults (N=18) with suprasacral complete SCI. Interventions Sacral nerve root stimulation (SNRS) via a functional magnetic stimulator (FMS) or a sacral anterior root stimulator (SARS) implant; and surface functional electrical stimulation (FES). Main Outcome Measures Interface pressure under the ischial tuberosity (IT) defined as peak pressure, gradient at peak pressure, and average pressure. Results With optimal FMS, a 29% average reduction of IT peak pressure was achieved during FMS (mean +/SD: 160.1+/-24.3mmHg at rest vs 114.7+/-18.0mmHg during FMS, t5=6.3, P=.002). A 30% average reduction of peak pressure during stimulation via an SARS implant (143.2+/-31.7mmHg at rest vs 98.5+/-21.5mmHg during SARS, t5=4.4, P=.007) and a 22% average decrease of IT peak pressure during FES stimulation (153.7+/-34.8mmHg at rest vs 120.5+/26.1mmHg during FES, t5=5.3, P=.003) were obtained. In 4 participants who completed both the FMS and FES studies, the percentage of peak pressure reduction with FMS was slightly greater than with FES (mean difference, 7.8%; 95% confidence interval, 1.6%-14.0; P=.04). Conclusions SNRS or surface FES can induce sufficient gluteus maximus contraction and significantly reduce ischial pressure. SNRS via an SARS implant may be more convenient and efficient for frequently activating the gluteus maximus. Publication type: Journal: Article Source: EMBASE Full text: Available ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION at Archives of Physical Medicine and Rehabilitation Full text: Available ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION at Salisbury District Hospital Healthcare Library 33.Title: Prospective study of deep vein thrombosis in patients with spinal cord injury not receiving anticoagulant therapy. Citation: Spinal Cord, 01 April 2015, vol./is. 53/4(306-309), 13624393 Author(s): Matsumoto, S, Suda, K, Iimoto, S, Yasui, K, Komatsu, M, Ushiku, C, Takahata, M, Kobayashi, Y, Tojo, Y, Fujita, K, Minami, A Language: English Abstract: Study Design:Prospective cross-sectional study.Objectives:To investigate the timing of deep vein thrombosis (DVT) onset secondary to spinal cord injury without anticoagulant therapies.Setting:Spinal Cord Injury Center in Hokkaido, Japan.Methods:Between November 2012 and June 2013, patients with spinal cord injury who were admitted to our hospital within 1 day after the injury and treated surgically within 24 h underwent a neurological examination, leg vein ultrasonography and D-dimer test 1, 3, 7, 14 and 28 days after surgery. All patients received treatment with intermittent pneumatic compression and elastic stockings, but without any anticoagulant.Results:DVT developed in 12 patients (11 men and 1 women), with a mean age of 62.2 years (range, 41-80 years; mean age of total sample, 63.2 years (range, 25-78 years)), all distal to the popliteal vein. DVT occurred more often with a more severe paralysis (66.3%, AIS A and B). The median (± standard error) length of time from the operation to DVT detection was 7.5±2.2 days. The mean D-dimer level upon DVT detection was 14.6±11.8 μg ml−1, with no significant differences between those who developed DVT and those who did not at any of the time points.Conclusion:These results suggest that DVT can develop at the veryacute stage of spinal cord injury and the incidence increases with a more severe paralysis. DVT detection was more reliable with ultrasonography, which should be used with DVT-preventive measures, beginning immediately after the injury, for the management of patients with spinal cord injury. Publication type: journal article Source: CINAHL Full text: Available Nature Publishing Group at Spinal Cord 34.Title: Resilience in the initial year of caregiving for a family member with a traumatic spinal cord injury Citation: Journal of Consulting and Clinical Psychology, 2015, vol./is. 82/6(1072-1086), 0022-006X;1939-2117 (2015) Author(s): Elliott T.R., Berry J.W., Richards J.S., Shewchuk R.M. Language: English Abstract: Objective: Individuals who assume caregiving duties for a family member disabled in a traumatic injury often exhibit considerable distress, yet few studies have examined characteristics of those who may be resilient in the initial year of caregiving. Reasoning from the influential Pearlin model of caregiving (Pearlin & Aneshensel, 1994) and the resilience process model (Bonanno, 2005), we expected a significant minority of caregivers would be chronically distressed and another group would be resilient throughout the inaugural year of caregiving for a person with a traumatic spinal cord injury (SCI), and these groups would differ significantly in primary and secondary stress and in personal resources and mediators. Method: Twenty men and 108 women who identified as caregivers for a family member who incurred a traumatic SCI consented to complete measures during the inpatient rehabilitation and at 1 month, 6 months, and 12 months postdischarge. Results: Latent growth mixture modeling of depression symptoms over time revealed 3 groups of caregivers: chronic (24%), recovery (24%) and resilient (48%). The chronic group reported more anxiety, negative affect, and ill health than the other 2 groups throughout the year. The resilient group was best characterized by their enduring levels of positive affect and supportive social networks. Conclusions: A large percentage of individuals are resilient in the initial year of caregiving, and those who have problems adapting exhibit significant distress soon following the traumatic event. Early detection of and psychological interventions for individuals who have difficulty adjusting are indicated, as their distress is unlikely to abate untreated over the year. Publication type: Journal: Article Source: EMBASE Full text: Available ProQuest at Journal of Consulting and Clinical Psychology 35.Title: Restoring walking after spinal cord injury: Operant conditioning of spinal reflexes can help Citation: Neuroscientist, April 2015, vol./is. 21/2(203-215), 1073-8584;1089-4098 (19 Apr 2015) Author(s): Thompson A.K., Wolpaw J.R. Language: English Abstract: People with incomplete spinal cord injury (SCI) frequently suffer motor disabilities due to spasticity and poor muscle control, even after conventional therapy. Abnormal spinal reflex activity often contributes to these problems. Operant conditioning of spinal reflexes, which can target plasticity to specific reflex pathways, can enhance recovery. In rats in which a right lateral column lesion had weakened right stance and produced an asymmetrical gait, up-conditioning of the right soleus H-reflex, which increased muscle spindle afferent excitation of soleus, strengthened right stance and eliminated the asymmetry. In people with hyperreflexia due to incomplete SCI, down-conditioning of the soleus H-reflex improved walking speed and symmetry. Furthermore, modulation of electromyographic activity during walking improved bilaterally, indicating that a protocol that targets plasticity to a specific pathway can trigger widespread plasticity that improves recovery far beyond that attributable to the change in the targeted pathway. These improvements were apparent to people in their daily lives. They reported walking faster and farther, and noted less spasticity and better balance. Operant conditioning protocols could be developed to modify other spinal reflexes or corticospinal connections; and could be combined with other therapies to enhance recovery in people with SCI or other neuromuscular disorders. Publication type: Journal: Review Source: EMBASE 36.Title: Sacral anterior root stimulation improves bowel function in subjects with spinal cord injury. Citation: Spinal Cord, 01 April 2015, vol./is. 53/4(297-301), 13624393 Author(s): Rasmussen, M M, Kutzenberger, J, Krogh, K, Zepke, F, Bodin, C, Domurath, B, Christensen, P Language: English Abstract: Study design:Cross-sectional study.Objective:To evaluate the long-term effect of the sacral anterior root stimulator (SARS) on neurogenic bowel dysfunction in a large, well defined spinal cord injury (SCI) cohort.Setting:Department of Neuro-Urology, Bad Wildungen, Germany.Methods:Subjects undergone surgery at for SARSSDAF (sacral deafferentation) between September 1986 and July 2011 (n=587) answered a questionnaire. In total, 277 SARS subjects were available for the baseline (recall) and follow-up comparison.Results:Median age was 49 years (range: 19-80), time from SCI to surgery was 10 years (range: 0-49) and from surgery to follow-up 13 (range: 1-25). Of the responders 73% used SARS for bowel emptying. On visual analog scale (VAS) ranging from 0-10 (best), satisfaction with SARS was 10. Baseline and follow-up comparison showed a decline in the median VAS score 0-10 (worst) for bowel symptoms from 6 (range: 4-8) to 4 (range: 2-6), P<0.0001; median neurogenic bowel dysfunction score from 17 (range: 112) to 11 (range: 9-15), P<0.0001; median St Marks score from 4 (range: 0-7) to 4 (range: 0-5), P=0.01; and median Cleveland constipation score from 7 (range: 6-10) to 6 (range: 4-8), P<0.0001. Use of suppositories, digital evacuation and mini enema and subjects totally dependent on assistance during defecation were significantly lower after SARS.Conclusions:The SARS has the potential to be one of the few treatment methods targeting multiple organ dysfunctions following SCI. Publication type: journal article Source: CINAHL Full text: Available Nature Publishing Group at Spinal Cord 37.Title: Safety and efficacy of at-home robotic locomotion therapy in individuals with chronic incomplete spinal cord injury: A Prospective, pre-post intervention, proof-of-concept study Citation: PLoS ONE, March 2015, vol./is. 10/3, 1932-6203 (24 Mar 2015) Author(s): Rupp R., Schliessmann D., Plewa H., Schuld C., Gerner H.J., Weidner N., Hofer E.P., Knestel M. Language: English Abstract: Background: The compact Motorized orthosis for home rehabilitation of Gait (MoreGait) was developed for continuation of locomotion training at home. MoreGait generates afferent stimuli of walking with the user in a semisupine position and provides feedback about deviations from the reference walking pattern. Objective: Prospective, prepost intervention, proof-of-concept study to test the feasibility of an unsupervised home-based application of five MoreGait prototypes in subjects with incomplete spinal cord injury (iSCI). Methods: Twenty-five (5 tetraplegia, 20 paraplegia) participants with chronic (mean time since injury: 5.8 +/5.4 (standard deviation, SD) years) sensorimotor iSCI (7 ASIA Impairment Scale (AIS) C, 18 AIS D; Walking Index for Spinal Cord Injury (WISCI II): Interquartile range 9 to 16) completed the training (45 minutes/day, at least 4 days/week, 8 weeks). Baseline status was documented 4 and 2 weeks before and at training onset. Training effects were assessed after 4 and 8 weeks of therapy. Results: After therapy, 9 of 25 study participants improved with respect to the dependency on walking aids assessed by the WISCI II. For all individuals, the short-distance walking velocity measured by the 10-Meter Walk Test showed significant improvements compared to baseline (100%) for both self-selected (Mean 139.4% +/35.5%(SD)) and maximum (Mean 143.1% +/40.6%(SD)) speed conditions as well as the endurance estimated with the sixminute walk test (Mean 166.6% +/72.1% (SD)). One devicerelated adverse event (pressure sore on the big toe) occurred in over 800 training sessions. Conclusions: Home-based robotic locomotion training with MoreGait is feasible and safe. The magnitude of functional improvements achieved by MoreGait in individuals with iSCI is well within the range of complex locomotion robots used in hospitals. Thus, unsupervised MoreGait training potentially represents an option to prolong effective training aiming at recovery of locomotor function beyond in-patient rehabilitation. Trial Registration: German Clinical Trials Register (DKRS) DRKS00005587 Publication type: Journal: Article Source: EMBASE Full text: Available ProQuest at PLoS ONE Full text: Available ProQuest at PLoS One 38.Title: Secondary neurological deterioration in traumatic spinal injury: Data from medicolegal cases Citation: Bone and Joint Journal, April 2015, vol./is. 97B/4(527-531), 2049-4394;2049-4408 (01 Apr 2015) Author(s): Todd N.V., Skinner D., Wilson-MacDonald J. Language: English Abstract: We assessed the frequency and causes of neurological deterioration in 59 patients with spinal cord injury on whom reports were prepared for clinical negligence litigation. In those who deteriorated neurologically we assessed the causes of the change in neurology and whether that neurological deterioration was potentially preventable. In all 27 patients (46%) changed neurologically, 20 patients (74% of those who deteriorated) had no primary neurological deficit. Of those who deteriorated, 13 (48%) became Frankel A. Neurological deterioration occurred in 23 of 38 patients (61%) with unstable fractures and/or dislocations; all 23 patients probably deteriorated either because of failures to immobilise the spine or because of inappropriate removal of spinal immobilisation. Of the 27 patients who altered neurologically, neurological deterioration was, probably, avoidable in 25 (excess movement in 23 patients with unstable injuries, failure to evacuate an epidural haematoma in one patient and over-distraction following manipulation of the cervical spine in one patient). If existing guidelines and standards for the management of actual or potential spinal cord injury had been followed, neurological deterioration would have been prevented in 25 of the 27 patients (93%) who experienced a deterioration in their neurological status. Publication type: Journal: Article Source: EMBASE Full text: Available Highwire Press at Bone and Joint Journal, The 39.Title: Selective alpha adrenergic antagonist reduces severity of transient hypertension during sexual stimulation after spinal cord injury Citation: Journal of Neurotrauma, March 2015, vol./is. 32/6(392-396), 0897-7151;1557-9042 (15 Mar 2015) Author(s): Phillips A.A., Elliott S.L., Zheng M.M.Z., Krassioukov A.V. Language: English Abstract: On a daily basis, the majority of those with high-level spinal cord injury have autonomic dysreflexia, which describes a life-threatening episode of transient extreme hypertension (i.e., as high as 300 mm Hg) as many as 90% of people living with this condition. Unfortunately, ejaculation is a major initiating factor for autonomic dysreflexia, which discourages sexual activity. In order to obtain a sperm specimen, or for initial assessment of fertility, penile vibrostimulation is clinically performed. Nifedipine, a selective calcium channel blocker, is the most commonly prescribed pharmaceutical for a priori management of autonomic dysreflexia secondary to ejaculation or other causes; however, it is limited because of its potential exacerbation of low resting pressure, which also affects this population. The present study examined the effect of a short-acting selective alpha1 antagonist (prazosin) on autonomic dysreflexia severity using a randomized placebo trial during medically supervised penile vibrostimulation in six males with cervical spinal cord injury. Beat-by-beat blood pressure and heart rate were recorded throughout penile vibrostimulation during placebo and prazosin-treated days. The increase in systolic blood pressure was mitigated during vibrostimulation in subjects administered prazosin as compared with those administered placebo (+140+/-19 mm Hg vs. +96+/-14 mmHg; p<0.05). On average, the peak in systolic blood pressure was 46 mm Hg lower during penile vibrostimulation when patients were administered prazosin (p<0.05), whereas resting blood pressure was not affected. Prazosin appears to be effective at reducing the severity of autonomic dysreflexia during sexual stimulation in patients with spinal cord injury, without exacerbating resting hypotension in high-level spinal cord injury. Publication type: Journal: Article Source: EMBASE 40.Title: Serum sCD95L concentration in patients with spinal cord injury Citation: Journal of International Medical Research, April 2015, vol./is. 43/2(250-256), 0300-0605;1473-2300 (19 Apr 2015) Author(s): Biglari B., Buchler A., Swing T., Child C., Biehl E., Reitzel T., Bruckner T., Ferbert T., Korff S., Rief H., Gerner H.-J., Moghaddam A. Language: English Abstract: Objective To determine serum concentrations of soluble CD95 ligand (sCD95L) in patients with traumatic spinal cord injury. Methods Patients with traumatic spinal cord injury were recruited. Blood was collected on admission to hospital and at 4h, 9h, 12h, 24h, 3 days, 7 days, and 2, 4, 8 and 12 weeks postadmission. Serum concentrations of sCD95L were determined via immunoassay. Result The study included 23 patients. Mean sCD95L concentrations were significantly lower at 4h, 9h, 12h and 24h than at admission, and were significantly higher at 8 and 12 weeks, compared with admission. Conclusion The serum sCD95L concentration fell significantly during the first 24h after traumatic spinal cord injury. Concentrations then rose, becoming significantly higher than admission levels at 8 weeks. sCD95L may represent a possible therapeutic target for traumatic spinal cord injury. Publication type: Journal: Article Source: EMBASE Full text: Available JOURNAL OF INTERNATIONAL MEDICAL RESEARCH at Journal of International Medical Research Full text: Available JOURNAL OF INTERNATIONAL MEDICAL RESEARCH at Salisbury District Hospital Healthcare Library 41.Title: Sexuality for women with spinal cord injury. Citation: Journal of sex & marital therapy, May 2015, vol. 41, no. 3, p. 238-253 (2015 May-Jun) Author(s): Cramp, Jackie D, Courtois, Frédérique J, Ditor, David S Abstract: The authors conducted a review of the literature on women's sexuality after spinal cord injury, including studies from 1990 to 2011 retrieved from PubMed. Several facets of a woman's sexuality are negatively affected by after spinal cord injury, and consequently, sexual satisfaction has been shown to decrease, which also negatively affects quality of life. Neurogenic bladder is common after spinal cord injury, and the resulting urinary incontinence is a top therapeutic priority of this population. To improve sexual satisfaction and quality of life for women with spinal cord injury, future research needs to explore the effects of urinary incontinence on various aspects of sexuality. Source: Medline The authors conducted a review of the literature on women's sexuality after spinal cord injury, including studies from 1990 to 2011 retrieved from PubMed. Several facets of a woman's sexuality are negatively affected by after spinal cord injury, and consequently, sexual satisfaction has been shown to decrease, which also negatively affects quality of life. Neurogenic bladder is common after spinal cord injury, and the resulting urinary incontinence is a top therapeutic priority of this population. To improve sexual satisfaction and quality of life for women with spinal cord injury, future research needs to explore the effects of urinary incontinence on various aspects of sexuality. Source: Medline 42.Title: Should suspected cervical spinal cord injury be immobilised?: A systematic review Citation: Injury, April 2015, vol./is. 46/4(528-535), 0020-1383;1879-0267 (01 Apr 2015) Author(s): Oteir A.O., Smith K., Stoelwinder J.U., Middleton J., Jennings P.A. Language: English Abstract: Background Spinal cord injuries occur worldwide; often being life-threatening with devastating long term impacts on functioning, independence, health, and quality of life. Objectives Systematic review of the literature to determine the efficacy of cervical spinal immobilisation (vs no immobilisation) in patients with suspected cervical spinal cord injury (CSCI); and to provide recommendations for prehospital spinal immobilisation. Methods Searches were Background Spinal cord injuries occur worldwide; often being life-threatening with devastating long term impacts on functioning, independence, health, and quality of life. Objectives Systematic review of the literature to determine the efficacy of cervical spinal immobilisation (vs no immobilisation) in patients with suspected cervical spinal cord injury (CSCI); and to provide recommendations for prehospital spinal immobilisation. Methods Searches were conducted of the Cochrane library, CINAHL, EMBASE, Pubmed, Scopus, Web of science, Google scholar, and OvidSP (MEDLINE, PsycINFO, and DARE) databases. Studies were included if they were relevant to the research question, published in English, based in the prehospital setting, and included adult patients with traumatic injury. Results The search identified 1471 citations, of which eight observational studies of variable quality were included. Four studies were retrospective cohorts, three were case series and one a case report. Cervical collar application was reported in penetrating trauma to be associated with unadjusted increased risk of mortality in two studies [(OR, 8.82; 95% CI, 1.09-194; p = 0.038) & (OR, 2.06; 95% CI, 1.35-3.13)], concealment of neck injuries in one study and increased scene time in another study. While, in blunt trauma, one study indicated that immobilisation might be associated with worsened neurological outcome (OR, 2.03; 95% CI, 1.03-3.99; p = 0.04, unadjusted). We did not attempt to combine study results due to significant heterogeneity of study design and outcome measures. Conclusion There is a lack of high-level evidence on the effect of prehospital cervical spine immobilisation on patient outcomes. There is a clear need for large prospective studies to determine the clinical benefit of prehospital spinal immobilisation as well as to identify the subgroup of patients most likely to benefit. Publication type: Journal: Review Source: EMBASE 43.Title: Temporizing after Spinal Cord Injury. Citation: Hastings Center Report, 01 March 2015, vol./is. 45/2(8-10), 00930334 Author(s): Volpe, Rebecca L., Crites, Joshua S., Kirschner, Kristi L. Language: English Abstract: Mr. C is a twenty-two-year-old who was flown to a level-1 trauma center after diving headfirst into shallow water. Prior to this accident, he was in excellent health. At the scene, he had been conscious but was paralyzed and had no sensation below his neck. The emergency medical services team immobilized Mr. C's neck with a cervical collar and intubated him for airway protection before transport. As Mr. C's medical care proceeds, he expresses a desire for extubation, although it was not clear that he had the capacity to make this (or any other) decision. It also was unclear whether this desire reflected his authentic wishes to be allowed to die or stemmed from feelings of discomfort and agitation. Over a period of several days, Mr. C's sedation was lightened, and the psychiatry service conducted a formal decision-making capacity assessment. Mr. C continues to express a desire to withdraw life-sustaining medical treatment. However, the psychiatry service is concerned that Mr. C seems to lack adequate insight into what it would mean to die. What does it mean to respect Mr. C's autonomy? Publication type: journal article Source: CINAHL 44.Title: The efficiency of mechanical orthoses in affecting parameters associated with daily living in spinal cord injury patients: a literature review. Citation: Disability & Rehabilitation: Assistive Technology, 01 May 2015, vol./is. 10/3(183-190), 17483107 Author(s): Ahmadi Bani, Monireh, Arazpour, Mokhtar, Farahmand, Farzam, Mousavi, Mohmmad Ebrahim, Hutchins, Stephen William Language: English Abstract: Objective: The most simple and common approach in providing standing and walking by subjects with spinal cord injury (SCI) is the use of mechanical orthoses. These include traditional orthoses, medial linkage orthoses (MLOs) and reciprocating gait orthoses (RGOs). Independence, energy expenditure, gait parameters, system reliability and cosmesis are important factors in orthotic design. The aim of this review was to compare the evidence of existing mechanical orthoses to that of other types regarding these factors . Methods: The preferred reporting items for systematic reviews and meta-analyses (PRISMA) method was used by an experience researcher based on selected keywords and their composition and an electronic search was performed in well-known databases. Results: Twenty articles were selected for final evaluation. Many were case studies, and also had limited and heterogeneous sample sizes with different instruments used for evaluation. The results of the analysis demonstrated that independence and cosmesis are improved when using MLOs, but gait parameters, energy expenditure and stability are all improved when using RGOs. Conclusion: Those mechanical orthoses which have reciprocal motion and congruency between the anatomical and orthotic joints have been shown to provide positive effects on patient lifestyles. However, further improvement is needed to more effectively meet the needs of SCI patients. Publication type: journal article Source: CINAHL 45.Title: Transcranial magnetic stimulation after spinal cord injury Citation: World Neurosurgery, February 2015, vol./is. 83/2(232-235), 1878-8750;1878-8769 (01 Feb 2015) Author(s): Awad B.I., Carmody M.A., Zhang X., Lin V.W., Steinmetz M.P. Language: English Abstract: Objective To review the basic principles and techniques of transcranial magnetic stimulation (TMS) and provide information and evidence regarding its applications in spinal cord injury clinical rehabilitation. Methods A review of the available current and historical literature regarding TMS was conducted, and a discussion of its potential use in spinal cord injury rehabilitation is presented. Results TMS provides reliable information about the functional integrity and conduction properties of the corticospinal tracts and motor control in the diagnostic and prognostic assessment of various neurological disorders. It allows one to follow the evolution of motor control and to evaluate the effects of different therapeutic procedures. Motor-evoked potentials can be useful in follow-up evaluation of motor function during treatment and rehabilitation, specifically in patients with spinal cord injury and stroke. Although studies regarding somatomotor functional recovery after spinal cord injury have shown promise, more trials are required to provide strong and substantial evidence. Conclusions TMS is a promising noninvasive tool for the treatment of spasticity, neuropathic pain, and somatomotor deficit after spinal cord injury. Further investigation is needed to demonstrate whether different protocols and applications of stimulation, as well as alternative cortical sites of stimulation, may induce more pronounced and beneficial clinical effects. Publication type: Journal: Review Source: EMBASE 46.Title: Transfer of the brachialis to the anterior interosseous nerve as a treatment strategy for cervical spinal cord injury: Technical note Citation: Global Spine Journal, August 2015, vol./is. 5/2(110-117), 2192-5682;2192-5690 (06 Aug 2014) Author(s): Hawasli A.H., Chang J., Reynolds M.R., Ray W.Z. Language: English Abstract: Study Design Technical report. Objective To provide a technical description of the transfer of the brachialis to the anterior interosseous nerve (AIN) for the treatment of tetraplegia after a cervical spinal cord injury (SCI). Methods In this technical report, the authors present a case illustration of an ideal surgical candidate for a brachialis-to-AIN transfer: a 21-year-old patient with a complete C7 spinal cord injury and failure of any hand motor recovery. The authors provide detailed description including images and video showing how to perform the brachialis-to-AIN transfer. Results The brachialis nerve and AIN fascicles can be successfully isolated using visual inspection and motor mapping. Then, careful dissection and microsurgical coaptation can be used for a successful anterior interosseous reinnervation. Conclusion The nerve transfer techniques for reinnervation have been described predominantly for the treatment of brachial plexus injuries. The majority of the nerve transfer techniques have focused on the upper brachial plexus or distal nerves of the lower brachial plexus. More recently, nerve transfers have reemerged as a potential reinnervation strategy for select patients with cervical SCI. The brachialis-to-AIN transfer technique offers a potential means for restoration of intrinsic hand function in patients with SCI. Publication type: Journal: Article Source: EMBASE 47.Title: Treatment of detrusor external sphincter dyssynergia using ultrasound-guided trocar catheter transurethral botulinum toxin A injection in men with spinal cord injury Citation: Archives of Physical Medicine and Rehabilitation, April 2015, vol./is. 96/4(614-619), 0003-9993;1532-821X (01 Apr 2015) Author(s): Yang W.X., Zhu H.J., Chen W.G., Zhang D.W., Su M., Feng J.F., Liu C.D., Cai P. Language: English Abstract: Objective To evaluate the effects of transrectal ultrasound-guided trocar catheter transurethral botulinum toxin A (BTX-A) injection into the external urethral sphincter (EUS) for treating detrusor external sphincter dyssynergia (DESD) in men with spinal cord injury (SCI). Design Descriptive study. Setting Hospital rehabilitation department. Participants Patients (N=15; mean age, 40.5y; range, 22-64y) with suprasacral SCI with confirmed DESD determined by urodynamic study. Interventions A single dose of 100U BTX-A was injected into the EUS via transrectal ultrasound-guided trocar catheter transurethral injection. Main Outcome Measures Maximal detrusor pressure, detrusor leak point pressure, maximal pressure on static urethral pressure profilometry, postvoid residual volume, and maximal flow rate. Results After BTX-A transurethral injection, 4 (28.5%) patients showed an excellent result and 7 (46.7%) patients showed an improved result, whereas 4 (28.5%) patients experienced treatment failure. The overall success rate was 75.2%. We observed a significant decrease in static urethral pressure (P<.05) and detrusor leak point pressure after treatment (P<.05), but not in detrusor pressure. The postvoid residual volume were significantly decreased in the fourth week after treatment (P<.05). Conclusions Transrectal ultrasound-guided trocar catheter transurethral BTX-A injection into the EUS effectively suppresses or ameliorates DESD. A potential advantage of the method is that ultrasound guidance may not be necessary in the next injection. Publication type: Journal: Article Source: EMBASE Full text: Available ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION at Archives of Physical Medicine and Rehabilitation Full text: Available ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION at Salisbury District Hospital Healthcare